Media Release

PRESS RELEASE: Redistribute costs of health and social care fairly for all patients, urges think tank

A new system of charges is needed for an integrated NHS and social care service to distribute the costs of care more fairly across the system, to make funding more sustainable and to incentivise patients to prevent health needs and costs arising, urges a major new report by think tank the Social Market Foundation (SMF).

Putting Patients in Charge: The future of health and social care calls for the introduction of Personal Care Accounts, where both the individual and the state contribute towards the costs of NHS and social care treatments. The SMF’s funding model puts health and social care on an equal footing and brings to an end the current unfair settlement where individuals face huge financial liabilities for social care, while the cost for their health needs is almost entirely paid for by the state. It would do this by redistributing £7 billion of charging that currently falls solely on social care patients in a more equitable way to all health and social care patients through expanded charging for health services.

Putting Patients in Charge says Personal Care Accounts would redistribute the costs of social care more fairly across the population, provide a broader revenue base to meet the challenge of a £12billion funding gap in health and social care services by 2020 and provide a ‘nudge’ to encourage individuals to take preventative action to mitigate health needs and costs arising, thereby reducing the pressure on NHS services.

Under the SMF’s Personal Care Accounts:

  • The individual would make co-payments set at a small percentage of the actual cost of care.
  • Payments would be capped as a per annum charge and as a total lifetime charge, with the state paying for the remaining costs.
  • Those on low incomes or with low levels of wealth would be exempt.
  • Reforms would be introduced on a cost neutral basis: the level of charges in the future system would not exceed the levels of charges in the current system. To ensure that those with ‘moderate’ social care needs are eligible for support, this would mean redistributing £7 billion of charging that currently falls solely on social care patients to all health and social care patients.

Nigel Keohane, report author and SMF Research Director, commented:

“The UK’s current care system imposes many costs on the individual but they are spread very unevenly and haphazardly across different aspects of care (social care, dental care, optometry and prescriptions). This is unfair, illogical and inefficient, and people face markedly differing costs and experiences simply because of the nature of their condition: have a broken leg and be dealt with for free; have dementia and face care costs into the tens of thousands.

There is little point talking about integrated care unless we address this huge anomaly. A ‘Personal Care Account’ would spread the private costs that currently apply in care more evenly across society and would make the system fairer. By broadening the number of contributors and making the costs more transparent, the scheme would also boost the sustainability of funding into the future.”

Putting Patients in Charge also tackles how to commission integrated health and social care services, recommending that the next government should follow the Greater Manchester example in all areas and put all funding relevant to a patient’s needs in the hands of a single local commissioner. The paper also argues that NHS England should seek to promote innovative commissioning approaches and promote the role that the market can play in delivering integrated care. As part of the NHS Five Year Forward View, the SMF proposes that NHS England trial two commissioning models in local areas:

  • All-out care – under this outcome-based approach, local Health and Well-Being Boards and Clinical Commissioning Groups would commission an external provider to achieve specified health and well-being outcomes for the local population. The provider would bring together health, social care and community services to meet these outcomes.
  • Patient First Budgets – under this choice-based approach, the patient (guided by GPs and other professionals) would determine what units or packages of care or support to buy using public funding from a personalised budget. Any unpaid care provided by family and friends would become eligible for at least partial remuneration.

Nigel Keohane, report author and SMF Research Director, commented:

“To achieve more integrated and better care, we must allow commissioners and providers to innovate and adopt new practices rapidly. In part, this means putting funding for health and social care in the hands of one local commissioner. But, beyond this, it means a fuller role for the market whether it is individual patients purchasing their own care packages or providers taking on responsibilities for whole groups of patients.”





  • Embargoed copies of Putting Patients in Charge: The future of health and social care are available on request. Please contact Sean O’Brien via
  • The Social Market Foundation (SMF) is a leading UK think tank established in 1989 with the aim of marrying market economies with social justice. We develop innovative ideas across a broad range of economic and social policy, taking a pro-market rather than free-market approach.


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